Early coronary angiography in patients after out‐of‐hospital cardiac arrest without ST‐segment elevation: Meta‐analysis of randomized controlled trials

Freund, Anne; Royen, Niels van; Kern, Karl B.; Jobs, Alexander; Thiele, Holger; Lemkes, Jorrit S.; Desch, Steffen

doi:10.1002/ccd.30355

Cited by 9 publications

(6 citation statements)

References 20 publications

(27 reference statements)

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“…This meta-analysis included previously unreported data for subgroups and thus updates and expands on previous meta-analyses [ 20 , 21 ]. The present findings corroborate that a strategy of early coronary angiography is not superior over a strategy of delayed/selective coronary angiography in OHCA patients without ST-segment elevation.…”

Section: Discussionmentioning

confidence: 98%

Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials

Hamidi¹,

Anwari²,

Spaulding³

et al. 2023

Clin Res Cardiol

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Background Recent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high pretest probability of coronary artery disease may benefit from early CAG remains unclear. Methods We included all randomized controlled trials that compared a strategy of early/immediate versus delayed/selective CAG in OHCA patients and no ST elevation and had a follow-up of at least 30 days. The primary outcome of interest was all-cause death. Odds ratios (OR) were calculated and pooled across trials. Interaction testing was used to assess for heterogeneity of treatment effects. Results In total, 1512 patients (67 years, 26% female, 23% prior myocardial infarction) were included from 5 randomized controlled trials. Early/immediate versus delayed/selective CAG was not associated with a statistically significant difference in odds of death (OR 1.12, 95%-CI 0.91–1.38), with similar findings for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95%-CI 0.89–1.36). There was no effect modification for death by age, presence of a shockable initial cardiac rhythm, history of coronary artery disease, presence of an ischemic event as the presumed cause of arrest, or time to return of spontaneous circulation (all P-interaction > 0.10). However, early/immediate CAG tended to be associated with higher odds of death in women (OR 1.52, 95%-CI 1.00–2.31, P = 0.050) than in men (OR 1.04, 95%-CI 0.82–1.33, P = 0.74; P-interaction 0.097). Conclusion In OHCA patients without ST-segment elevation, a strategy of early/immediate versus delayed/selective CAG did not reduce all-cause mortality across major subgroups. However, women tended to have higher odds of death with early CAG. Graphical abstract

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Section: Discussionmentioning

confidence: 98%

Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials

Hamidi¹,

Anwari²,

Spaulding³

et al. 2023

Clin Res Cardiol

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“…Although in the absence of ST segment elevation percutaneous coronary intervention (PCI) in this population is no longer routinely recommended, where there is haemodynamic instability it should still be considered. 17,18 There is observational data that early angiography benefits those who go on to survive with a good neurological outcome 19 and that this benefit may be higher in younger patients. 20 However, neurological outcome will not be known at an early time point following admission where angiography may be beneficial.…”

Section: Discussionmentioning

confidence: 99%

Neurological outcome following out of hospital cardiac arrest: Evaluation of performance of existing risk prediction models in a UK cohort

Livesey,

Lone,

Black

et al. 2023

Journal of the Intensive Care Society

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Introduction: Out of hospital cardiac arrest (OHCA) is a common problem. Rates of survival are low and a proportion of survivors are left with an unfavourable neurological outcome. Four models have been developed to predict risk of unfavourable outcome at the time of critical care admission – the Cardiac Arrest Hospital Prognosis (CAHP), MIRACLE2, Out of Hospital Cardiac Arrest (OHCA), and Targeted Temperature Management (TTM) models. This evaluation evaluates the performance of these four models in a United Kingdom population and provides comparison to performance of the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score. Methods: A retrospective evaluation of the performance of the models was conducted over a 43-month period in 414 adult, non-pregnant patients presenting consecutively following non-traumatic OHCA to the five units in our regional critical care network. Scores were generated for each model for where patients had complete data (CAHP = 347, MIRACLE2 = 375, OHCA = 356, TTM = 385). Cerebral Performance Category (CPC) outcome was calculated for each patient at last documented follow up and an unfavourable outcome defined as CPC ⩾ 3. Performance for discrimination of unfavourable outcome was tested by generating receiver operating characteristic (ROC) curves for each model and comparing the area under the curve (AUC). Results: Best performance for discrimination of unfavourable outcome was demonstrated by the high risk group of the CAHP score with an AUC of 0.87 [95% CI 0.83–0.91], specificity of 97.1% [95% CI 93.8–100] and positive predictive value (PPV) of 96.3% [95% CI 92.2–100]. The high risk group of the MIRACLE2 model, which is significantly easier to calculate, had an AUC of 0.81 [95% CI 0.76–0.86], specificity of 92.3% [95% CI 87.2–97.4] and PPV of 95.2% [95% CI 91.9–98.4]. Conclusion: The CAHP, MIRACLE2, OHCA and TTM scores all perform comparably in a UK population to the original development and validation cohorts. All four scores outperform APACHE-II in a population of patients resuscitated from OHCA. CAHP and TTM perform best but are more complex to calculate than MIRACLE2, which displays inferior performance.

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“…12 The outcome of recent randomized controlled trials comparing early with delayed coronary angiography [13][14][15] has been evaluated by meta-analysis. 16 A total of 1167 patients received early (within 120 min or as soon as possible) or delayed (after neurological recovery or after at least 6-24 h) coronary angiography. All-cause mortality was 44.6% in the early coronary angiography group and 40.2% in the delayed/selective group (OR, 1.19; 95% CI, 0.94-1.52; P = 0.15).…”

Section: Coronary Reperfusionmentioning

confidence: 99%

“…The optimal timing of coronary angiography in patients without signs of ongoing myocardial ischemia or ST-segment elevation on their ECG has been debated 12. The outcome of recent randomized controlled trials comparing early with delayed coronary angiography13–15 has been evaluated by meta-analysis 16. A total of 1167 patients received early (within 120 min or as soon as possible) or delayed (after neurological recovery or after at least 6–24 h) coronary angiography.…”

Section: Current Evidencementioning

confidence: 99%

Post-Cardiac Arrest Syndrome

Penketh

Nolan

2023

Journal of Neurosurgical Anesthesiology

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Post-cardiac arrest syndrome (PCAS) is a multicomponent entity affecting many who survive an initial period of resuscitation following cardiac arrest. This focussed review explores some of the strategies for mitigating the effects of PCAS following the return of spontaneous circulation. We consider the current evidence for controlled oxygenation, strategies for bloodpressure targets, the timing of coronary reperfusion, and the evidence for temperature control and treatment of seizures. Despite several large trials investigating specific strategies to improve outcomes after cardiac arrest, many questions remain unanswered. Results of some studies suggest that interventions may benefit specific subgroups of cardiac arrest patients, but the optimal timing and duration of many interventions remain unknown. The role of intracranial pressure monitoring has been the subject of only a few studies, and its benefits remain unclear. Research aimed at improving the management of PCAS is ongoing.

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Early coronary angiography in patients after out‐of‐hospital cardiac arrest without ST‐segment elevation: Meta‐analysis of randomized controlled trials

Cited by 9 publications

References 20 publications

Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials

Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials

Neurological outcome following out of hospital cardiac arrest: Evaluation of performance of existing risk prediction models in a UK cohort

Post-Cardiac Arrest Syndrome

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